Interprofessional observerships provide insight
By Dr. Lindsay Davidson, Collaborator Lead
For several years, first year medical students have had the opportunity to shadow a non-physician health care provider for a half day as part of the Introduction to Professional Roles course. This initiative, championed by Dr. Sanfilippo, initially involved nurses at one institution and has grown to include 3 sites (KGH, HDH and PCCC) and 11 different groups of health care providers. First year students are charged with beginning to understand their role (as future physicians) as well as the role(s) of the myriad types of health care providers that they will work with over the course of their careers. Most years, the Observerships have been preceded by an in-class brainstorming session, where student infer what various professionals’ roles might be. Following this, students are assigned to work with one of the available health care providers during curricular time. This practical experience allows students to act as ‘anthropologists’, observing for themselves what various health care providers actually do, day-to-day as well as how they collaborate with patients, family members and other members of their team. Finally, at the end of term, students convene in groups to compare and debrief their experiences, collating new lists of the roles and functions that they have observer, to be contrasted with their initial brainstorming. Invariably, the end-of-term collations reflect the insight of the experiences that they have shared.
Here are some of the observations students have made:
“I liked being able to be a part of the meetings with families so that I could better understand what role the social worker played.”
“My preceptor was very approachable and forthcoming with information about her profession; she seemed very enthusiastic about participating in the IP program.”
“… I just had not thought about how the social worker-patient encounter would rely on the same trust- and rapport-building methods as the physician physicians do.”
“I had pictured a dietitian’s work to be office-based, with patients coming for consults at her desk. It never occurred to me that in the hospital, they would accompany the rest of the health teams to do rounds.”
“And I now appreciate the importance of an OT in helping a patient adapt to their new health and return to their normal life as best as possible.”
“I had envisioned a solemn chaplain giving last rites, but clearly this is not the role of the spiritual care practitioner at KGH. Instead, I was surprised by the breadth of the role – there are people who do not consider themselves spiritual or religious at all, yet still speak at length with the spiritual care practitioner about their life and their thoughts about death.”
“I believe it is important to be aware of how physicians can collaborate with allied health professionals to provide the best care, recognizing that we cannot do everything.”
The Interprofessional (IP) Observership has been met with enthusiasm by students and our hospital partners alike and this year, we are offering students the opportunity to participate in an optional second observership, to broaden their experience an understanding of their future IP colleagues. Additionally, in 2017-18, we will be piloting an advanced IP Observership at the Kingston Community Health Centre, where groups of students will spend half a day observing a team-based Interprofessional clinic in our community.
With thanks to students Sarah Edgerley, Shannon Willmott, Ameir Makar, and Etienne Benard-Seguin who have been working on tracking and analyzing the Interprofessional Observership experience.
Teaching the Way You Practice: Collaborative Active Learning in Different Teaching Settings
By Michelle Gibson (email@example.com) and Melissa Andrew (firstname.lastname@example.org)
Most health professionals are actively engaged in collaborative practice: working with many different team members from different disciplines to support patients or clients in achieving their health goals.
However, we often teach our learners in isolation from one another, and, if we are being honest, co-teaching and integration between disciplines in an educational setting can be challenging. When it ‘works’, however, it is very rewarding, and it is an opportunity to role-model explicitly for learners how different disciplines with differing approaches can work together to enhance care. When co-teaching is combined with active learning that mimics the wonderful messiness of real clinical practice, learners can start to envision how complex problems are approached in “real-life”. In our experience, this is particularly powerful when we have students also working in teams on complex, real-world cases.
We offer up tips and lessons learned in six years shared teaching between geriatric medicine and geriatric psychiatry in undergraduate and post-graduate settings, to different audiences. We have also co-taught with other health care disciplines but our examples come from our co-teaching.
Examples of what we teach together:
- Second year medical students: We built on-line modules for students to use first on dementia and delirium, and then we co-teach the session that applies this learning to real-life cases. Dr. Andrew co-teaches a 2nd session on “Brain and Behaviour” with a psychogeriatric resource consultant.
- Family Medicine residents: We have 2 half-days which deal with common, complex, outpatient problems in older adults: the patient who arrives on a Friday afternoon with falls, confusion, and a letter from an anxious daughter; the patient who is extremely cognitively impaired, falling frequently, with a nightmarish medication list, and no family members who can provide history; this same patient who has a valid drivers’ license, and who may or may not be depressed.
Tip # 1: Start with being clear about your purpose(s), goals, objectives.
While this is important for all teaching, it becomes essential when more than one individual is involved. For example, when we started to design academic half-days for family medicine residents, we worked out that we were aiming to help them approach complex patients with multiple problems in an outpatient setting, while highlighting how geriatric psychiatry and geriatric medicine are similar, how they are different, and how we work together. These sessions work best with a shared vision.
Tip #2: Be explicit about roles and expectations.
Similar to Tip #1, this does get increasingly complex when more than one (extremely passionate and very dedicated) teacher is involved in any learning event. Who is preparing what? By when? How are the different parts going to be taught? There is nothing worse than realizing the day before that you were the one expected to prepare the quiz. J
Tip #3: Avoid ‘parallel play’.
Some attempts at integration or co-teaching end up being a series of lectures or teaching sessions that happen to be scheduled in approximately the same time period and are not really integrated. The best sessions involve a back-and-forth approach, with many opportunities to address areas of controversy in a respectful manner. (See Tip #4)
Tip #4: Embrace controversy, respectfully.
Junior learners in particular, in our experience, become stressed when it appears there is no one “right” answer. We live, wallow, and celebrate the land of the gray-zone in geriatrics (pun intended), so we rarely have one correct answer. However, how we address this in our teaching is important. We frequently check in with one another: “How would you approach this in your setting?” and acknowledge strengths in differing approaches.
Tip #5: Embrace complexity, carefully.
We have been pleasantly surprised as to how groups of learners are able to work together to approach very complex cases, when there is a safe learning environment. For example, we give learners a very complex medication list, while providing an approach for them to practice, and we emphasize that there are many ‘right’ answers. When we debrief this exercise, we use our different backgrounds/expertise to help students navigate the pros and cons of different decisions. The team setting for teaching appears to allow students to feel safe to address areas of discomfort – that wondrous gray zone in which we revel. We all consult when there is a great deal of complexity, and we should role-model this for our learners.
Tip #6: Play your best cards.
This is a great time to determine who is best at which parts, and use these skills to your advantage. This applies both to clinical expertise, but also to teaching styles: who is the best person to teach X? Who is better at addressing this particular issue? Why not compensate for each other’s’ weaknesses? You also have the huge benefit of learning from your colleague.
Lesson #1: It takes more time up front, but less time the more you do it. The discussions, planning, negotiations about “what is the way we want to approach X” does require more time initially, but it gets easier each time.
Lesson #2: If possible, it’s best (in our opinion), and more fun, to co-teach with people that you work with regularly. The established trust and long-standing respectful relationships, we believe, shine through for learners, allowing them to feel comfortable when we ‘disagree’ on certain issues. This is much easier to do in a collegial way when you know how the other teachers work and think. Plus, teaching with friends is fun.
Lesson #3: Going out for lunch to plan teaching is optimal. ‘Nuff said. Seriously, though – it’s hard to plan teaching in the midst of busy clinical work. Set aside time to think about things, and to meet in a positive environment.
Lesson #4: Where there is assessment involved, co-marking is hugely informative – as in, set aside time, sit down together, and mark together. It allows us to delve into why students thought X, when clearly we thought we were teaching Y. There is also the distinct advantage of being able to share the marking load, whilst sipping on pleasant beverages. More importantly, though, by discussing the answers, we are able to immediately adapt our teaching plans for the following year.